Granulomas.

What are they? 

Granulomas are tiny red bumps that can appear on the stoma but are more often around the edge of the stoma, where it joins the skin. They can be crumbly and might bleed easily because there are a lot of capillaries (little blood vessels) in there. They’re really just nodules of tissue. 

What causes them? 

White blood cells accumulate in an area of injury, where their role is to remove bacteria and other microscopic debris that might prevent healing or cause infection. That’s a good thing. But sometimes, they “over heal,” like white blood cells on steroids, and they form these tiny overgrowths of tissue.  

Obviously, the granulomas started as a response to some kind of injury. For example, it might be from the skin being irritated by overly forceful cleaning, an allergic reaction to your appliance, the baseplate rubbing around the stoma because the hole is too small, or the stoma rubbing up against the pouch because your clothes or belt are pressing against it. The formation of granulomas might also be a delayed reaction to sutures from your surgery (even if it was a long time ago). No-one seems to understand why granulomas only form occasionally, in response to these common types of injury or irritation. That’s still a mystery.  

Treatment 

By themselves, granulomas are harmless. More of a nuisance, really. If they’re not bothering you, you can live with them forever, and many people do. But sometimes granulomas can be uncomfortable or painful or too big, and if they bleed too much they can cause baseplate adhesion problems. This is definitely something to discuss with your physician or stoma nurse – first to get a firm diagnosis of granulomas, and then to develop a treatment plan. 

• It might be enough just to eliminate the aggravating factors (e.g., by cleaning more gently, wearing looser clothing, or putting a lubricating product in your pouch to reduce rubbing against the stoma). 
• Medical treatment often involves applying a corticosteroid or cauterizing the granulomas with silver nitrate (chemically burning them to destroy the tissue and reduce their size). That’s not as bad as it sounds. Cauterizing is often used for other things like getting rid of unwanted warts or skin tags. If that doesn’t help or if the granulomas keep returning, they’re sometimes removed surgically under a local anesthetic. 

Courtesy Joan Scott, author of The Ostomy Raft